Physical Performance Limitations After Severe Lower Extremity Trauma in Military Service Members

*Center for the Intrepid, Brooke Army Medical Center, Fort Sam Houston, TX;†Department of Orthopedics and Rehabilitation, San Antonio Military Medical Center, Fort Sam Houston, TX;‡Department of Physical Therapy and Rehabilitation Science, The University of Iowa, Iowa City, IA;§U.S. Army-Baylor University Doctoral Program in Physical Therapy, Fort Sam Houston, TX; and‖United States Army Institute of Surgical Research, Fort Sam Houston, TX.

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Abstract

Objectives:To characterize the type and magnitude of lower extremity physical performance deficits in military service members who have undergone rehabilitation after limb salvage or transtibial amputation.Design:Cross-sectional prospective.Setting:Level I trauma military medical and rehabilitation center.Patients/Participants:Service members with lower extremity trauma resulting in limb salvage (n = 20) or unilateral transtibial amputation (n = 14) compared with uninjured actively training service members (n = 123).Intervention:Control participants and individuals with amputation were tested during a single session. Participants with limb salvage were tested with and without the use of a custom carbon fiber orthosis.Main Outcome Measurements:Physical performance as measured using four-square step, sit-to-stand 5 times, and timed stair ascent tests. Secondary outcomes included the associations between these lower extremity activity measures to determine the interrelationship of activity limitations.Results:The ability of service members to rapidly ascend stairs, a demanding lower limb mobility task, is limited after amputation and limb salvage. However, performance on an agility test similar to the four-square step test approximated normative levels. Differences between individuals with amputation or limb salvage were less than 1 second for all tests and were not statistically significant. Correlations were observed among the physical performance measures in the tested patient populations, particularly between the sit-to-stand and timed stair ascent tests.Conclusions:Severe limb trauma significantly affects performance, particularly during tasks requiring lower extremity strength and power. Individuals with amputation or limb salvage who were provided a custom carbon fiber orthosis and intensive rehabilitation had similar performance.Level of Evidence:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.